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Symptoms of a Ruptured Spleen

A ruptured spleen causes abdominal pain, usually severe, but not always. The severity and even the location of the pain depend on how badly the spleen has ruptured and how much blood leaks out. Pain may be felt in these locations:

Left side of the abdomen under the rib cage

Left shoulder, because nerves of the left shoulder and left side of the diaphragm originate from the same location and the rupture may irritate these nerves

Internal bleeding caused by the ruptured spleen can cause blood pressure to drop. This can cause:

How Is a Ruptured Spleen Diagnosed?

A physical exam may be the only test done to diagnose a ruptured spleen. The doctor will feel the person's belly area. The abdominal area may feel hard and look swollen (distended) because it has filled with blood. If there has been a great deal of blood loss from the spleen, the patient may have low blood pressure and a rapid heart rate. Sudden low blood pressure in someone who is believed to have a spleen injury, particularly a young person, is a sign that the condition is especially severe, and emergency surgery is needed.

How Is a Ruptured Spleen Diagnosed?

Imaging tests can help diagnose a ruptured spleen. A computed tomography (CT) scan of the abdomen is one of the most common methods used. During the test, a special substance, called contrast, is injected into a vein, usually in the arm. The contrast helps the doctor determine the amount of bleeding from the spleen. Active bleeding from the spleen may not be seen on an abdominal CT scan without contrast.

However, a CT scan of the abdomen may only be done if time allows. A CT scan with contrast may take awhile, and some people with spleen ruptures have died while waiting to have the test done. For this reason, a CT scan is not recommended for those with a spleen rupture who have unstable vital signs or low blood pressure due to the injury (suggesting shock).